Нутритивная поддержка больных новой коронавирусной инфекцией - Научно-практический журнал Cardioсоматика Том 12, №2 (2021)

Нутритивная поддержка больных новой коронавирусной инфекцией

Пасечник И.Н. Нутритивная поддержка больных новой коронавирусной инфекцией. CardioСоматика. 2021; 12 (2): 102–109. DOI: 10.26442/22217185.2021.2.200858

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Pasechnik IN. Nutritional support for patients with new coronavirus infection. Cardiosomatics. 2021; 12 (2): 102–109. DOI: 10.26442/22217185.2021.2.200858

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Аннотация

Пандемия новой коронавирусной инфекции (COVID-19) стала беспрецедентной угрозой жизни для заболевших и увеличила нагрузку на систему здравоохранения большинства стран. Тяжесть течения COVID-19 не всегда предсказуема. Однако коморбидная патология и пожилой возраст являются факторами риска тяжелого течения болезни с развитием полиорганной недостаточности. Пристальное внимание клиницистов при лечении COVID-19 уделяется нутритивной поддержке как компоненту интенсивной терапии. Также коррекция пищевого статуса важна при реабилитации больных с синдромом после интенсивной терапии. Цель обзора – показать необходимость дифференцированного подхода к нутритивной поддержке больных COVID-19 на этапах лечения и реабилитации. Из более 200 первично отобранных источников литературы из различных баз (Scopus, Web of science, РИНЦ и др.) для анализа оставили 49 публикаций в основном за последние 5 лет, более ранние статьи использовали при сохранении их актуальности для клиницистов. В обзоре представлены данные о методах оценки пищевого статуса больных COVID-19. Подчеркивается, что у пациентов с коморбидной патологией и больных пожилого возраста часто развивается нутритивная недостаточность, углубляющаяся в процессе заболевания. Подробно разбираются вопросы коррекции нутритивной недостаточности в зависимости от тяжести течения заболевания и этапа лечения. Эффективность реабилитационных мероприятий повышается при адекватной нутритивной поддержке. Современные подходы к обеспечению больных COVID-19 нутриентами и энергией предусматривают градацию назначения нутритивной поддержки в зависимости от тяжести заболевания. Акцент делается на постепенном достижении целевых значений белка и энергии, преимущественном использовании энтерального способа доставки пищевых компонентов. Преемственность в коррекции пищевого статуса на амбулаторном, стационарном и реабилитационном этапах повышает качество оказания помощи больным COVID-19.

Ключевые слова: новая коронавирусная инфекция, COVID-19, нутритивная поддержка

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The novel coronavirus infection (COVID-19) pandemic has become an unprecedented threat to the lives of those affected and has increased the burden on the healthcare system in most countries. The severity of COVID-19 is not always predictable. However, comorbid pathology and advanced age are risk factors for a severe course of the disease with the development of multiple organ failure. When treating COVID-19, clinicians place particular emphasis on nutritional support as part of intensive care. Correction of nutritional status is also important in the rehabilitation of patients with the syndrome after intensive care. The aim of the review was to show the need for a differentiated approach to nutritional support for patients with COVID-19 during treatment and rehabilitation. From more than 200 originally selected literature sources from various databases (Scopus, Web of science, RSCI, etc.), 49 publications were selected for analysis, mostly published over the past 5 years. Earlier articles were used if they were still relevant to clinicians. The review provides methods for assessing the nutritional status of patients with COVID-19. It is emphasized that patients with comorbid pathology and elderly patients often develop malnutrition, which progresses over the disease. The article discusses in detail the issues of correction of malnutrition, depending on the severity of the disease and the stage of treatment. The effectiveness of rehabilitation is enhanced with adequate nutritional support. Current approaches to providing COVID-19 patients with nutrients and energy include a gradation of nutritional support prescription depending on the severity of the disease. Particular attention is paid to the gradual achievement of target protein and energy levels, as well as the preferential use of the enteral method of delivery of food components. Continuity of nutritional status correction at the outpatient, inpatient and rehabilitation stages improves the quality of care for patients with COVID-19.

Keywords: novel coronavirus infection, COVID-19, nutritional support

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1. Tsai P-H, Lai W-Y, Lin Y-Y, et al. Clinical manifestation and disease progression in COVID-19 infection. J Chin Med Assoc. 2021;84(1):3-8. DOI:10.1097/JCMA.0000000000000463
2. Bouadma L, Lescure FX, Lucet JC, et al. Severe SARS-CoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med. 2020;46(4):579-82. DOI:10.1007/s00134-020-05967-x
3. Thakur V, Ratho RK, Kumar P, et al. Multi-Organ Involvement in COVID-19: Beyond Pulmonary Manifestations. J Clin Med. 2021;10(3):446. DOI:10.3390/jcm10030446
4. Mishu MA, Samiha F, Zahan K, et al. Multi-organ Dysfunction Due to SARS-CoV-2 Infection: A Comparative Overview. Am J Internal Med. 2021;9(1):26-35.
5. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. DOI:10.1016/S0140-6736(20)30566-3
6. Cava E, Neri B, Carbonelli MG, et al. Obesity pandemic during COVID-19 outbreak: Narrative review and future considerations. Clin Nutr. 2021;40(4):1637-43. DOI:10.1016/j.clnu.2021.02.038
7. Piers R, Janssens W, Cobbaert K, et al. Letter to the Editor: Premorbid Frailty is a better Prognostic Indicator than Age in Oldest-Old Hospitalized with COVID-19. J Am Med Dir Assoc. 2021;22(3):514-6. DOI:10.1016/j.jamda.2021.01.059
8. Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10-47. DOI:10.1016/j.clnu.2018.05.024
9. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. DOI:10.1016/S0140-6736(20)30211-7
10. Barazzoni R, Bischoff SC, Breda J, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020;39(6):1631-8. DOI:10.1016/j.clnu.2020.03.022
11. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. DOI:10.1016/j.clnu.2018.08.037
12. Suárez-Llanos JP, Rosat-Rodrigo A, García-Niebla J, et al. Comparison of Clinical Outcomes in Surgical Patients Subjected to CIPA Nutrition Screening and Treatment versus Standard Care. Nutrients. 2019;11(4):pii:E889. DOI:10.3390/nu11040889
13. Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults. Br J Nutr. 2004;92(5):799-808. DOI:10.1079/bjn20041258
14. Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116-22. DOI:10.1016/s0899-9007(98)00171-3
15. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36. DOI:10.1016/s0261-5614(02)00214-5
16. Canales C, Elsayes A, Yeh DD, et al. Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients? JPEN J Parenter Enteral Nutr. 2019;43(1):81-7. DOI:10.1002/jpen.1181
17. Coruja MK, Cobalchini Y, Wentzel C, Fink JDS. Nutrition Risk Screening in Intensive Care Units: Agreement Between NUTRIC and NRS 2002 Tools. Nutr Clin Pract. 2020;35(3):567-5719. DOI:10.1002/ncp.10419
18. Rattanachaiwong S, Zribi B, Kagan I, et al. Comparison of nutritional screening and diagnostic tools in diagnosis of severe malnutrition in critically ill patients. Clin Nutr. 2020;39(11):3419-25. DOI:10.1016/j.clnu.2020.02.035
19. Short KR, Kedzierska K, van de Sandt CE. Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Front Cell Infect Microbiol. 2018;8:343. DOI:10.3389/fcimb.2018.00343
20. Rozga M, Cheng FW, Moloney L, Handu D. Effects of Micronutrients or Conditional Amino Acids on COVID-19-Related Outcomes: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet. 2020. DOI:10.1016/j.jand.2020.05.015
21. Jayawardena R, Sooriyaarachchi P, Chourdakis M, et al. Enhancing immunity in viral infections, with special emphasis on COVID-19: A review. Diabetes Metab Syndr. 2020;14(4):367-82. DOI:10.1016/j.dsx.2020.04.015
22. van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care. 2019:23:368. DOI:10.1186/s13054-019-2657-5
23. Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19). A Review. JAMA. 2020;323(18):1824-36. DOI:10.1001/jama.2020.6019
24. Pasechnik IN. Nutritional support for patients with coronavirus infection in critical conditions. Anesthesiology and resuscitation. 2020;3:70-5 (in Russian)
DOI:10.17116/anaesthesiology202003170
25. Im JH, Je YS , Baek J, et al. Nutritional status of patients with COVID-19. Int J Infect Dis. 2020;100:390-3. DOI:10.1016/j.ijid.2020.08.018
26. Galmés S, Serra F, Palou A. Current State of Evidence: Influence
of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework. Nutrients. 2020;12(9):2738. DOI:10.3390/nu12092738
27. Singer P, Rattanachaiwong S. To eat or to breathe? The answer is both! Nutritional management during noninvasive ventilation. Crit Care. 2018;22(1):27. DOI:10.1186/s13054-018-1947-7
28. Bendavid I, Singer P, Theilla M, et al. NutritionDay ICU: a 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr. 2017;36(4):1122-9. DOI:10.1016/j.clnu.2016.07.012
29. So EC, Chen YH, Wonget KL, et al. A new mask designed for patients implanted with a nasogastric tube. Med Eng Phys. 2008;30(8):1020-3. DOI:10.1016/j.medengphy.2007.09.007
30. Gervasio J. Total Nutrient admixtures (3-in-1): Pros vs. Cons for adults. Nutr Clin Pract. 2015;30:331-5. DOI: 10.1177/0884533615578458
31. Alfonso JE, Berlana D, Boullata J. Clinical, Ergonomic and Economic outcomes with multichamber bags compared with (Hospital) Pharmacy compounded bags and multibottle systems: A systemic Literature review. J Parenter Enter Nutr. 2017;41:1162-77. DOI:10.1177/0148607116657541
32. Itzhaki MH, Singer P. Advances in Medical Nutrition Therapy: Parenteral Nutrition. Nutrients. 2020;12(3):pii:E717. DOI:10.3390/nu12030717
33. Pradelli L, Mayer K, Klek S, et al. ω-3 Fatty-Acid Enriched Parenteral Nutrition in Hospitalized Patients: Systematic Review With Meta-Analysis and Trial Sequential Analysis. JPEN J Parenter Enteral Nutr. 2020;44(1):44-57. DOI:10.1002/jpen.1672
34. Stehle P, Ellger B, Kojic D, Feuersenger A. Glutamine Dipeptide-Supplemented Parenteral Nutrition Improves the Clinical Outcomes of Critically Ill Patients: A Systematic Evaluation of Randomised Controlled Trials. Clin Nutr ESPEN. 2017;17:75-85. DOI:10.1016/j.clnesp.2016.09.007
35. Dmitriev AV, Machulina IA, Shestopalov AE. Role of pharmaco- and micronutrients in nutritional metabolic therapy of COVID-19 and other viral infections. Medical alphabet. 2021;4:56-63 (in Russian) DOI: 10.33667/2078-5631-2021-4-56-63
36. Pasechnik IN, Gubaidullin RR, Borisov AYu. Fundamentals of nutritional support for patients in critical conditions. Moscow: RIA “Colosseum”, 2012 (in Russian)
37. Pasechnik IN. Nutritional support for critically il patients (Review). General Reanimatology. 2020;16(4):40-59 (in Russian) DOI:10.15360/1813-9779-2020-4-40-59
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Авторы

И.Н. Пасечник

1 ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ, Москва, Россия;
2 Главное медицинское управление Управления делами Президента РФ, Москва, Россия
*pasigor@yandex.ru

________________________________________________

Igor N. Pasechnik

1 Central State Medical Academy, Moscow, Russia;
2 Main Medical Directorate of the Administrative Department of the President of the Russian Federation, Moscow, Russia
*pasigor@yandex.ru

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